How to Make Sure Your Veterinary Crash Kit is Ready to Go 

5 July 2024 -
Clinical Cases & Research, Practice Management

Author: Dr Rosalind Wright MRCVS 

A good veterinary crash kit is pivotal in any emergency situation and every practice should have one. When it comes to effective cardiopulmonary resuscitation (CPR), having the right drugs and equipment on hand can make the difference between life and death. But it’s not as simple as just stocking a vet crash box. Ensuring the kit is well-organised and providing written aids and suitable staff training will vastly improve the efficiency of your CPR efforts.  

Veterinary crash kits – the basics 

Crash kits can be designed to suit your vet practice’s needs. Toolboxes can be adapted for smaller settings and carts or units of drawers might be more suitable for larger veterinary hospitals.  Whatever you decide, your crash kit should be portable, either on wheels or with a carry handle, and designed so that each item is easily accessible. 

Location is key – place your kit in a central area where critical patients are assessed, oxygen is available, and animals are routinely anaesthetised. It may be necessary to have one crash kit in the main prep area and another in theatre. If your setting does require multiple crash kits, the design and layout should be standardised for ease of use. 

Labelling is crucial. The crash kit should be easy to identify, visible at all times and have a set position that it is returned to after every use. Each drawer or section should be labelled too. A common design is to stock drawers according to their function and a full alphabetic list of contents should be mounted on each drawer. 

An example of a crash cart layout might include: 

Top of trolley: monitoring equipment. If you are using a box, position the monitoring equipment next to the crash box. 

  • Drawer 1: Airway  
  • Drawer 2: Intravenous (IV) access 
  • Drawer 3: Drugs 
  • Drawers 4 + 5: Additional equipment (labelled on each drawer) 

Top tip: Hang a step stool on the side of the trolley or a nearby wall to allow staff enough height to provide effective chest compressions. 

Stocking your veterinary crash kit – the essentials 

Stocking your veterinary crash kit will depend on the type of vet practice you work in and the frequency and type of emergencies you see. Based on the design described above, here is a crash cart checklist of essential items that you should consider including in your crash cart or box: 

Monitoring: 

  • Capnography – this is the mainstay of CPR monitoring and crucial in identifying return of spontaneous circulation (ROSC) 
  • Pulse oximeter 
  • Blood pressure equipment 
  • Electrocardiogram (ECG) – arrhythmias may alter your choice of medication and affect your decision to defibrillate. However, ECG readings and auscultation should not be prioritised over chest compressions. 

Airway: 

  • Endotracheal (ET) tubes – various sizes, prepped with ties and with capped capnography adapters  
  • Laryngoscope with different size blades, working bulbs, and spare bulbs and batteries 
  • Local anaesthetic spray for feline airways 
  • Canine urinary catheter for endotracheal drug administration where IV access cannot be rapidly secured  
  • Ambubag for manual ventilation in situations where the patient cannot quickly be moved to the oxygen supply (e.g. collapsed large dogs)
  • Tracheostomy tubes (where a full tracheostomy kit is not included in the crash box) 

IV access:

  • IV catheters (various sizes) 
  • Tourniquet 
  • Intraosseous catheter (if available) or large needle for intraosseous access 
  • Alcohol wipes 
  • Small supply of tape and bandaging material 
  • Small bag of saline for flushing 
  • Small selection of needles and syringes (1ml, 3ml – can be preassembled) 
  • Scalpels or cut-down kit 
  • Working clippers 
  • Sterile gloves 
  • Butterfly needles and 50ml syringe (if thoracocentesis kit is not included) 
  • Bag of saline for fluid boluses and 10ml syringes for flushing medications
  • Giving set 

Drugs:

  • Adrenaline (as per RECOVER dosing guidelines, dosing every 2 minutes during asystole) 
  • Atropine (routinely used for asystole alternating with adrenaline or bradycardia due to high vagal tone) 
  • Naloxone (opioid reversal) 
  • Atipamozole (alpha-2 agonist reversal) 
  • Lidocaine (for ventricular fibrillation or pulseless ventricular tachycardia – use defibrillator first if available) 
  • Induction agent (e.g. propofol)  
  • Glucose (indicated in hypoglycaemic patients, e.g. sepsis, neonates, insulin overdose, etc.) 

When designing your kit, remember to protect drugs from light as necessary. Each drug should have a labelled place in the drawer or tray of the crash box. A foam insert with cut-outs can act as a divider for bottles and vials. Medications with similar names should be separated by other drugs to prevent errors. 

Stocking your vet crash kit – optional items 

  • Procedure kits can be prepared and sterilised to save time in an emergency, e.g. chest drain/thoracocentesis grab kit, tracheostomy grab kit. 
  • Defibrillator – ensure your defibrillator is suitable for veterinary patients and staff are familiar with its safe use. 
  • Timer +/- metronome feature – use of an auditory aid has been shown to increase the accuracy of chest compression rate.  
  • Sterile suction unit. 
  • Additional drugs: calcium gluconate, furosemide, diazepam, norepinephrine, dobutamine, antiarrhythmics e.g. amiodarone. 

Maintaining your vet practice crash kit 

How often should a crash cart be checked?  

The crash kit should be restocked and tidied after every use or once daily. A full list of all crash kit items should be attached to the box or trolley to make it easier to see what should be in there. 

A full maintenance check should be performed and signed off monthly. Check all medications are present and in date. The monthly check should include: 

  • Full stock check 
  • Check all sterile equipment and procedure kits are sealed and in date 
  • Replace preassembled needles and syringes 
  • Check laryngoscope bulbs are all in working order 
  • Defibrillator check 

Optimising your pet CPR 

Cognitive aids will dramatically improve your team’s approach to resuscitation and should be laminated and attached to the crash cart. If you have space, wall charts are useful too. A number of invaluable resources are available via VECCS and the RECOVER initiative, including CPR record sheets, a CPR algorithm and emergency drugs charts. Not only do EVECCS (European Veterinary Emergency & Critical Care Society) and VECCS (Veterinary Emergency and Critical Care Society) provide members with lots of CPR resources, but they also offer member discounts for Improve Veterinary Education veterinary emergency certificate courses.

‘Hot debriefing’ is popular in human hospitals and should occur immediately after CPR. It allows the whole team to discuss and reflect on the event with the aim of improving future performance. This no-blame process is adapted from human medicine. Hot debriefs have led to changes in human clinical practice and they provide psychological support following traumatic clinical incidents.  

Of course, having your dream veterinary crash cart and lots of comprehensive resources is of limited value if staff can’t find equipment or struggle with CPR techniques.  New members of staff must familiarise themselves with the crash box and everyone should receive regular formal resuscitation training. In addition, impromptu crash drills can be a fun and useful learning experience; however, let your team know that a drill is planned that day to prevent confusion.  

Veterinary emergency CPD

If you want to go the extra step and improve your veterinary emergency and critical care, Improve Veterinary Education offers a vast range of ECC CPD for vets and veterinary nurses (see links below). Additional training in ECC can provide a huge boost to the clinical confidence of a veterinary team, improve CPR leadership, and increase positive outcomes for your patients.  

Improve International ECC courses: 

Emergency and Critical Care Nursing  

Advanced Certificate in Emergency and Critical Care Nursing 

Save a Life Today: CPR in association with RECOVER (Interprofessional)  

Postgraduate Certificate & General Practitioner Certificate in Emergency Medicine and Surgery

Accelerated Emergency Programme 

 

References 

Genetti, A., Llewellyn, E.A. (2023) Usefulness of an auditory aid to improve chest compression rate accuracy during cardiopulmonary resuscitation. Journal of Veterinary Emergency and Critical Care (San Antonio) 33(6), 639-647  

Gilmartin, S., Martin, L., Kenny, S., et al. (2020) Promoting hot debriefing in an emergency department. British Medical Journal Open Quality. 9(3), e000913 

Jacquet, G.A., Hamade, B., Diab, K.A., et al. (2018) The Emergency Department Crash Cart: A systematic review and suggested contents. World Journal of Emergency Medicine 9(2), 93-98 

McMichael, M., Herring, J., Fletcher, D.J., (2012) RECOVER Preparedness and Prevention Domain Worksheet Authors. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 2: Preparedness and prevention. Journal of Veterinary Emergency and Critical Care (San Antonio) 22 Suppl 1, S13-25  

Rozanski, E.A., Rush, J.E., Buckley, G.J., et al. (2012) RECOVER Advanced Life Support Domain Worksheet Authors. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support. Journal of Veterinary Emergency and Critical Care (San Antonio) 22 Suppl 1, S44-64 

https://knowledge.rcvs.org.uk/document-library/hot-debrief-data-collection-form/ Accessed 24/6/24 

https://legacy.recoverinitiative.org/guidelines-2/#1689169392105-53f891be-d773 Accessed 24/6/24 

https://recoverinitiative.org/cpr-record-sheet/ Accessed 24/6/24 

https://veccs.org/product/cpr-emergency-drugs-22×27-poster-2/ Accessed 24/6/24